Using machine learning to enhance prediction of atrial fibrillation recurrence after catheter ablation

• Published in: Journal of arrhythmia Vol. 39; no. 6; pp. 868 - 875
• Main Authors: Brahier, Mark S., Zou, Fengwei, Abdulkareem, Musa, Kochi, Shwetha, Migliarese, Frank, Thomaides, Athanasios, Ma, Xiaoyang, Wu, Colin, Sandfort, Veit, Bergquist, Peter J., Srichai, Monvadi B., Piccini, Jonathan P., Petersen, Steffen E., Vargas, Jose D.
• Format: Journal Article
• Language: English
• Published: Tokyo John Wiley & Sons, Inc 01-12-2023; John Wiley and Sons Inc; Wiley
• Subjects: Ablation; Ablation (Surgery); Atrial fibrillation; Cardiac arrhythmia; cardiac computed tomography; Cardiovascular disease; catheter ablation; Catheters; CT imaging; Data mining; Deep learning; Heart failure; left atrium; Machine learning; Original; Patients; Risk factors; Variables; Vein & artery diseases
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1002/joa3.12927

Background
Traditional risk scores for recurrent atrial fibrillation (AF) following catheter ablation utilize readily available clinical and echocardiographic variables and yet have limited discriminatory capacity. Use of data from cardiac imaging and deep learning may help improve accuracy and prediction of recurrent AF after ablation.
Methods
We evaluated patients with symptomatic, drug‐refractory AF undergoing catheter ablation. All patients underwent pre‐ablation cardiac computed tomography (cCT). LAVi was computed using a deep‐learning algorithm. In a two‐step analysis, random survival forest (RSF) was used to generate prognostic models with variables of highest importance, followed by Cox proportional hazard regression analysis of the selected variables. Events of interest included early and late recurrence.
Results
Among 653 patients undergoing AF ablation, the most important factors associated with late recurrence by RSF analysis at 24 (+/−18) months follow‐up included LAVi and early recurrence. In total, 5 covariates were identified as independent predictors of late recurrence: LAVi (HR per mL/m2 1.01 [1.01–1.02]; p < .001), early recurrence (HR 2.42 [1.90–3.09]; p < .001), statin use (HR 1.38 [1.09–1.75]; p = .007), beta‐blocker use (HR 1.29 [1.01–1.65]; p = .043), and adjunctive cavotricuspid isthmus ablation [HR 0.74 (0.57–0.96); p = .02]. Survival analysis demonstrated that patients with both LAVi >66.7 mL/m2 and early recurrence had the highest risk of late recurrence risk compared with those with LAVi <66.7 mL/m2 and no early recurrence (HR 4.52 [3.36–6.08], p < .001).
Conclusions
Machine learning‐derived, full volumetric LAVi from cCT is the most important pre‐procedural risk factor for late AF recurrence following catheter ablation. The combination of increased LAVi and early recurrence confers more than a four‐fold increased risk of late recurrence.
We found that machine learning‐derived, full volumetric LAVi from cardiac computed tomography is the most important pre‐procedural risk factor for late AF recurrence following catheter ablation. The combination of increased LAVi and early recurrence conferred more than a four‐fold increased risk of late recurrence in our retrospective study of 653 patients undergoing catheter ablation for symptomatic, drug refractory atrial fibrillation.